Knowledge for better health: How to enhance the impact of research?

Science has contributed to dramatic improvements in health worldwide. The application of knowledge from research has prevented a tremendous amount of suffering and misery, and allowed billions of people to live longer, healthier lives. During the past decades, the global investment in research for health has grown to an estimated 300 billion USD per year. While the investment in research, and the expectations of its benefits continue to increase, there are constant signals of problems and disappointments with the relevance, acceptance and use of research. Researchers, and those who identify with their results, report that a lot of valuable knowledge and applications are hardly used, or only after a long time. In numerous publications, they point to the gap between today’s scientific advances and their application: between what is known and what is actually being done. Some well-known examples are studies that show that up to half of the patients in the United States and Europe are not receiving care according to best scientific evidence, and a major study on child survival in low-income countries, which concludes that 60% of the 10.8 million deaths among children could be prevented by simple, effective and affordable interventions. In this thesis, I try to present a richer, empirically ground and more useful perspective on KtA, which I refer to as the ‘pragmatist process perspective’. To develop this perspective, I drew upon insights from diverse fields such as science and technology studies, cognitive psychology, management and innovation studies, public administration, and epistemology. These diverse fields offer a rich mosaic of insights into KtA, in which a phenomenological theory of KtA is embedded. In chapter two, I present this perspective on how knowledge is produced, transferred and used to contribute to better action for health. The aim in this thesis is to explore how insights into producing, appraising, transferring and using knowledge, can be used to improve the contribution of knowledge practices to action for health. In diverse empirical case studies in the Netherlands, Guinea Bissau and Ghana, I explore how the process perspective can help to better analyze problems with KtA, and develop new and more productive approaches.